Russell Modern Dentistry, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

RUSSELL MODERN DENTISTRY, PC

Doing business as

Russell Modern Dentistry

Practice address

1710 NE 122ND Ave
Portland, OR 97230-1939

Phone

(503) 295-2120

Fax

(503) 305-3342

NPI assigned

Jan 7, 2022

Last updated

Jan 7, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sumeet S. Pandhoh, DDS

Title

Owner

Phone

(503) 295-2120

Specialties & licenses 1

Addresses

Other names 1

• Russell Modern Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kayla Ellis, DDS

  • General Practice Dentistry
  • Portland, OR
  • NPI 1003703406
  NPD
• Manerva Jeanette Hart, DDS

  • Dentist
  • Portland, OR
  • NPI 1457733529
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641513600000",
    "number": "1063173466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 NE 122ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972301939",
            "telephone_number": "503-295-2120",
            "fax_number": "503-305-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL MODERN DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-07",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A",
        "authorized_official_last_name": "PANDHOH",
        "authorized_official_first_name": "SUMEET",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-295-2120",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russell Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lucie M Russ, LCSW
• Sarha Elena Russ
• Yelizaveta Russ, PHARM.D.
• Fern Gilda Russak, MD
• Russell Counseling
• Alanna Russell, RN
• Alvin Russell
• Amy Kay Russell
• Barbara Jean Russell, PMHNP
• Becky Russell

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.